Unleashing the power of vaccine uptake to target the measles resurgence

Blog post from Councillor David Fothergill on the importance of vaccine uptake to help tackle the rise in measles cases.

Measles, mumps, and rubella (MMR) are more than just childhood illnesses. They are highly infectious diseases that can have severe consequences, particularly for babies and young children. Fortunately, we have the power to prevent these diseases through the MMR vaccine and maintaining high vaccine uptake is crucial to protect individuals and communities from outbreaks.

Officials from the UK Health Security Agency (UKHSA) recently reported a concerning increase in measles cases across the UK. Between January and April 2023, there were 49 reported cases, surpassing the total of 54 cases recorded in the entirety of 2022. Whilst most cases have been concentrated in London, instances of measles have also been detected throughout the country, some of which are linked to travel abroad.

These worrying statistics shed light on a declining trend in measles vaccination rates among children in recent years. According to official data, only 89 per cent of children aged two in England have received the first dose of the MMR vaccine, with a mere 85 per cent completing the recommended two doses by the age of five.

These rates fall significantly short of the World Health Organisation's (WHO) target of 95 per cent coverage, which is necessary to achieve and maintain elimination of the disease. Measles is so infectious that even a small decline in uptake can result in outbreaks – so it’s vital for us to maintain this target for two doses to prevent such outbreaks.

Why have vaccination rates fallen in recent years?

Reported cases of measles decreased in 2020, likely as a result of the social distancing and lockdown measures introduced to prevent COVID-19. As a result of fewer cases, it may be that measles hasn’t been viewed as a continuing threat, so vaccination may have been seen as less important. Some children missed out on their routine vaccines during the pandemic for a variety of reasons and still need to catch up on their vital doses. Vaccine hesitancy may also be a contributing factor, whilst pressure on primary care and a reduction in health visitors are also likely to be leading to lower uptake.

Fragmentation of vaccine responsibility – GPs provide the pre-school vaccines, while NHS England commission the school-aged services – has been suggested as another reason. A lack of consistency between call and re-call procedures between GP practices is also said to be a factor. Surveys suggest parents and carers do not always find it easy to access vaccination services at GP practices because of timing and availability of appointments or competing childcare responsibilities. Some families may not be registered with a GP, whilst balancing employment and family responsibilities may make it difficult for parents to take time off work to attend appointments.

What is the role of councils (and councillors) in increasing uptake?

Councils are not directly responsible for commissioning or delivering vaccine programmes, but they are in a unique position to understand the health needs of their local population, and support vaccination services to reach them.

This may be through helping immunisation teams work with frontline services such as health visitors or children’s centres or supporting pop-up vaccination clinics in under-vaccinated areas. Through our social media and wider health promotion work we can make residents aware of the importance of vaccination and counter any misinformation that is out there.

In many areas school-based immunisation programmes are run separately from 5-19 Healthy Child Programme services, but that is not the case in Stockport where the HPV, the teenage three-in-one booster and MenACWY vaccines programmes are delivered by the school nursing service.

Elsewhere, in Tower Hamlets, the council has sought to be innovative in the way it promotes the benefits of flu and routine vaccinations to children and their families. This includes the use of online videos, translated into community languages.

Councillors can act as champions in this area by working with their public health and school nursing teams to encourage vaccine uptake. This could include finding innovative ways to embed key immunisation messages within the community, such as by using videos and social media or running a community stakeholder event as part of a wider local review into vaccine uptake.

How can this declining trend be reversed?

The good news for parents and caregivers is that the MMR vaccine is highly effective and it is never too late to ensure children (or adults) receive this protection. In light of the decline in vaccination rates, parents are encouraged to contact their GP surgery to check their child's vaccination status and arrange any necessary doses. Parents can also refer to their child's personal child health record, commonly known as the red book, for vaccination information.

Sending reminders to parents that their child is due or overdue for their vaccine can help boost vaccine levels, whilst offering the vaccine in more accessible places such as family hubs and pop-up clinics can expand vaccination opportunities and help reach underserved populations. Providing posters and leaflets in various languages and formats are also key to reducing barriers to access. Health professionals (such as health visitors, school nurses and GPs) play a crucial role in addressing vaccination concerns and providing accurate information.

Surveillance and outbreak response are vital components of increasing uptake, and councils and their partners can play a key role. By strengthening surveillance systems, areas with low vaccine coverage can be identified and evidence-based strategies to increase uptake can be developed. Continuous monitoring of vaccine uptake rates and disease incidence allows health protection teams to assess the impact of any  interventions and make informed decisions for the future.

Where next?

By boosting MMR vaccine uptake at the national level, we can work towards  consigning these diseases to the history books. Councils are in a unique position to understand the health needs of their local population, and support vaccination services to reach them. If we can drive up vaccination rates, we can reduce illness and save lives.